Call it quits

In comparison to smoking cocaine or opiates, research indicates that it is much harder to quit smoking tobacco. The first step towards preparing for change would be to look into one’s relationship with smoking, writes Rashikkha Ra Iyer

A few years ago, one of my friends stated “Right, smoking time!” and then whizzed off to smoke. When this friend and I travelled together for a few days, I was taken aback to see that the times when my friend felt like smoking were quite the same every day. I was curious to know if this was something he controlled, however, he clarified that his body prompted him to do so. Neither of us then knew to articulate this as cravings/ urges prompted and maintained by withdrawals. However, these questions in my mind were later answered by the training that led me to qualify as a smoking cessation specialist practitioner.

The pre-eminent reinforcing component of tobacco is nicotine, the rush of which most smokers seek. Amidst the numerous ways in which tobacco is used, cigarette smoking is the most commonplace. A cigarette is a carefully crafted and highly engineered drug delivery system, although it doesn’t often get noticed. When a smoker finishes a cigarette, they’ve now received about 1 or 2 milligrams of nicotine. Nicotine reaches the brain at quite a rapid pace. It primarily works to attain peak levels in the bloodstream, post which it gains entry into the brain. A cigarette could span from 3-5 minutes to burn out completely and within this span of time, a smoker can take up to 10 puffs, sometimes 15. This thus explains why most people smoke more than one cigarette at a time.

Each time a person smokes a cigarette, there’s the nicotine rush felt in the body and consequently hits of nicotine in the brain. These hits coordinate with the number of cigarettes smoked in a day. Thus, should this be one pack of 20 cigarettes, it can then mean 200 hits of nicotine each day. More than smokeless ways of tobacco, cigarettes peak the blood at the fastest pace, hence why it is more sought after for immediate results. Most drug-seeking behaviours/addictions are maintained on the foundation of reward pathways in the brain, the neural circuitry that regulates drives, pleasures, reinforcement, assimilation of cues, conditioning and consequent behaviour manifestations. Very similar to that, nicotine also activates these reward pathways which lay at the forefront of nicotine dependence and addiction.

Most often, smokers believe that smoking helps them feel relieved of stress. Although this is the perceived experience, eventually smoking in itself starts to cause a spike in anxiety. This is true for people with co-occurring disorders such as depression/ schizophrenia. When having had a smoke, nicotine stimulates the adrenal glands that release epinephrine (adrenaline). Like in any other activity, the release of adrenaline stimulates the body and increases blood pressure, heart rate and respiration.

Most people who smoke, do want to quit, however, very few of them succeed without receiving the needed support from smoking cessation services.

Although most often smoking is looked at as a social behaviour that can be worked on through moral policing, nicotine dependence and addiction are very similar to other forms of addiction. Smoking tobacco can induce both physical and psychological dependence, which needs structured psychosocial and psychopharmacological support.

In comparison to smoking cocaine or opiates, research indicates that it is much harder to quit smoking. In a meta-analysis of 28 different studies conducted by a group of researchers in 2012, it was discovered that only 8% were able to quit smoking tobacco while 18% were able to quit drinking and 40% were able to quit opiates or cocaine. The first step towards preparing for change would be to look into one's relationship with smoking. If you do smoke and would like to approach a cessation service, it would be good to do some self-paced work before you do so. Writing down why you smoke can firstly help identify the numerous triggers that prompt you to do so. This can thus consequently inform the care plan you’d co-produce with your cessation practitioner, thus laying a strong foundation for a well-crafted recovery capital, that maximises abstinence and relapse prevention.

(The author is a multidisciplinary professional who works in the UK.)